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General NPI Number Information
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NPI Number | 1689989493
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Entity Type | Individual
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Provider Name | ELIZABETH ANN CLARK R.PH.
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Gender | Female
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 12830 WALKER BRANCH RD
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City | CHARLOTTE
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State | NC
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Zip | 28273-8850
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Country | US
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Telephone | 704-583-2602
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 S NEW HOPE RD
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City | GASTONIA
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State | NC
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Zip | 28056-2200
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Country | US
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Telephone | 704-854-4702
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Fax | 704-868-2690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8337
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12246
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License Number State | NC
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